The empirical in-depth study focuses on actors and processes of change in ambulatory care (research design step III – see Figure i.1). A combination of different methods (triangulation) and different actors and settings provides the best possibility to grasp intersections of interests and different sets of dynamics. A combination of quantitative and qualitative methods is chosen to link representative data on the occupational and organisational structure of office-based physicians and their attitudes on new health policies to specific areas (‘switchboards’) and groups of actors who ‘enable’ change. Prior to the main study, numerous expert interviews were conducted with representatives of institutions and associations in health care – including the two health occupations studied here – as well as explorative interviews with physicians. As described previously, the three occupational groups – physicians, physiotherapists and surgery receptionists – represent different positions in the stakeholder arrangement and the health workforce (Chapter Three). Close connections were built up with a number of representatives of institutions and associations during the research process, which enabled me to fill some of the data gaps, and to collect additional material and expert interviews during the research process.

Representatives of an association of SHI physicians, a physicians’ chamber and a SHI fund were interviewed in spring 2005 to provide an update as to how the process of merging providers is proceeding. In addition, expert information was collected from consumer representatives in the newly established regulatory boards of the DMPs, the physiotherapists’ association and university professors of physiotherapy, as well as surgery receptionists, in order to take the ongoing developments into account. These complex sources of information are included in the analysis, while details are given for the main study (Table A.1).

Following the structure of the German health care system, the focus is on the medical profession. A survey of physicians working in ambulatory care provides an overview of the occupational structure, work arrangements and the profession's attitudes to and appraisal of the major goals of new health policies. Physicians were surveyed by means of a short written questionnaire, which furnished the following data: (1) appraisal of goals and tools of health policy, for instance, new forms of medical regulation, contracting and the provision of care, EBM, user participation, quality management; (2) implementation level of these goals and tools in the surgery; (3) occupational structure, economic indicators and work arrangements; and (4) individual socialstatistical data, such as age and gender.